New Membership Application Member dues anniversary date is now based on the date of payment and no longer prorated to a December 1st anniversary date. Fields with BOLD labels are required + Show Member Option Descriptions Individual - $125 (currently $150 upon joining, $125 in subsequent years); 1 registered member, 1 login for email and attend events at discounted member rate Small Corporate - $300; 1 registered member, up to 9 logins for email and attending events at discounted member rates Medium Corporate - $400; 2 registered members, up to 99 logins for email and attending events at discounted member rates Large Corporate - $500; 3 registered members, unlimited logins for email and attending events at discounted member rates Student Members - $50.00; 1 login for email and attending events at discounted member rates Non- Profit - $100.00; 1 registered member, 1 login for email and attend events at discounted member rate if you are employed at a 501(c)(3) organization. Past President - $62.50;1 registered member, 1 login for email and attend events at discounted member rate Please Make A Selection Membership Level select Individual Membership $125 Small Corp. (1-9 Employees) Membership $300 Medium Corp. (10-99 Employees) Membership $400 Large Corp. (100+ Employees) Membership $500 Non- Profit Membership $100 Student Membership $50 Your Payment Will Be: User Account Set Up First Name Last Name Email Confirm Email Password * Password must be at least 8 characters in length and include; at least 1 capital letter, at least 1 lower case letter and at least 1 number. Member Information Organization Address City State select AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY Zip/Postal Code Phone (000-000-0000) Mobile (000-000-0000) Website Facebook Google+ Linkedin Twitter YouTube Number of years in business If you'd like others in your organization to receive email updates from AdFed Suncoast (ex: ADDY info, event alerts, etc.) - please enter their email addresses below. Corporate Member Option If signing up for a Medium or Large Corporate Membership, please enter the names and email addresses of your 1 or 2 other designated voting members. Please note, these members cannot be changed for 1 year. Affiliate log-ins can be requested here. Committee Interests Please check the committee areas that interest you: ADDY Awards Programs Communications Government Relations Public Relations Internet Diversity Public Service Education Membership Social Media Sponsorship Video Business Categories Which of the following most accurately describes your business? You may select up to two categories. Advertising Public Relations In House Marketing Department Job Placement Agency Corporate Marketing Officer Business Owner/Entrepreneur Copywriter Illustrator Art Director/Graphic Designer Interactive/Web/ Social Media Design Desktop Publishing Multimedia Photographer/Videographer Research Consulting Broadcast Television Cable Television Internet/Interactive Newspaper Outdoor Print Publications/Magazines/Directories Radio Audio-Video Duplication Pre-Production for Print Printing/Duplication Sales/Trade Show Exhibits Screen Printing Signs/Banners Video Production/Post Production Direct Mail/Fulfillment Educational Institution Government Miscellaneous Specialty Advertising Student Payment Payment Method Credit Card Card Type Visa Mastercard AMEX Card Owner's Name Card Number CVV Expiration Date (MM/YYYY) 01 02 03 04 05 06 07 08 09 10 11 12 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 . Be sure to click "Submit" one time only.Clicking "submit" more than once can result in duplicate charges to your credit card.